Ask the doctors: Former heavy smoker worried about damage

Dear Doctor: I started smoking when I was 25 and stopped when I was 40. I’m 56 now, and because I was a heavy smoker, I’m really worried about the damage I may have done. Do you think I can get scanned just to be sure everything is OK? Would my insurance pay for it?

Dear Reader: You are not alone in seeking reassurance about the effects of your former smoking habit. Both the federal government and private insurers agree that in cases like yours, lung cancer screenings may be useful.

Research published in the New England Journal of Medicine in 2011 found that when current and former heavy smokers underwent low-dose CT scans, which are a type of X-ray, to screen for cancer and for suspicious changes to lung tissues, a significant number of cancers were caught at an early stage. Researchers reported that the outcome of these screenings was a 20 percent reduction in lung cancer deaths among the population studied. That led to the current recommendation that adults between the ages of 55 and 80 who have smoked 30 packs of cigarettes per year within the last 15 years should undergo a scan. This recommendation covers current smokers and those who have quit within the last 15 years.

Lung cancer is the leading cause of cancer death in the United States, with smoking contributing to up to 90 percent of those deaths among both men and women. According to the American Lung Association, women who smoke are 13 times more likely than nonsmokers to go on to develop lung cancer. Among men, that likelihood goes up to 23 times the rate of nonsmokers. When people who don’t smoke are regularly exposed to secondhand smoke either at home or at work, their risk of developing lung cancer rises 20 to 30 percent. And as long as we’re on the topic, cigarette smoking accounts for about 20 percent of all deaths from heart disease in the U.S. All of which is leading us to our ongoing plea in these columns – if you’re a smoker, please stop. If you’re not, please don’t be tempted to start.

When it comes to the lung cancer screening recommendations, though, it’s important to note that it’s actually a complex issue. On the plus side is the fact that cancers caught early are easier to treat. However, screening includes the risk of a false-positive result. That’s when a test seems to identify disease when no disease is present. Also of concern is something known as over-diagnosis, which is the discovery of cancer that would not have caused problems to the patient. Each of these can lead to unnecessary procedures and treatment. That’s why screenings are recommended only for heavy smokers and only within a set time frame. For those who do get a positive result from a screening, it’s important to talk to your health care team about follow-up screenings. Our recommendation is to talk all of this over with your family doctor before you make any decisions regarding a lung cancer screening.